Unplanned Hospitalizations in the Year After Cancer Diagnosis

Key Points

Unplanned hospitalizations accounted for 67% of hospitalizations in the year after diagnosis.

67% of unplanned hospitalizations originated in the emergency department.

In a California population–based cohort study reported in the Journal of Oncology Practice, Whitney et al found that 67% of hospitalizations in the year after cancer diagnosis were unplanned, with 67% of such hospitalizations originating in the emergency department.

The study involved data from the California Cancer Registry linked with administrative inpatient data for 412,850 individuals diagnosed with cancer between 2009 and 2012. In the analysis of hospitalizations, those for maintenance chemotherapy, radiotherapy, or planned surgery were excluded.

Unplanned Hospitalizations and Their Causes

Among all patients, 62% had at least 1 all-cause hospitalization during the first year after diagnosis. Of these, 67% of hospitalizations were unplanned, with 35% of all patients having unplanned hospitalization.

In total, 67% of unplanned hospitalizations originated in the emergency department. The most common nonmalignancy principal diagnoses resulting in unplanned hospitalization included infection or fever (15.8%), complications of a medical device or care (6.5%), and gastrointestinal (5.8%), cardiovascular (5.8%), and respiratory (4.3%) diagnoses.

Of unplanned admissions originating in the emergency department, rates were lowest for thyroid (22.3%), breast (48.1%), and bone and soft tissue (49.1%) cancer, and highest for lung (78.6%), hepatobiliary or pancreatic (75.3%), and other digestive cancers (73.8%). Unplanned hospitalization rates were highest for patients with hepatobiliary or pancreatic cancer (2.08 unplanned hospitalizations per person-year at risk), lung cancer (1.58/person-year at risk), and brain or central nervous system cancer (1.47/person-year at risk). The lowest rates were found for patients with prostate cancer (0.18/person-year at risk) and melanoma (0.25/person-year at risk).

The investigators concluded, “The population burden of unplanned hospitalization among individuals newly diagnosed with cancer is substantial. Many unplanned hospitalizations originate in the [emergency department] and are associated with potentially preventable admission diagnoses. Efforts to reduce unplanned hospitalization might target subgroups at higher risk and focus on the [emergency department] as a source of admission.”